Early course and intervention in youth at-risk for psychosis: results from longitudinal studies

Original state of the art abstract, full audio lecture and original slide presentation by Raquel E. Gur (Lifespan Brain Institute / University of Pennsylvania, USA) on Early course and intervention in youth at-risk for psychosis: results from longitudinal studies (ESCAP 2017 Congress in Geneva, Switzerland).

AbstractThe increased focus on early identification of subthreshold psychotic symptoms provides an opportunity to examine the emergence of psychosis, follow individuals longitudinally and evaluate the effects of early intervention on functional outcome. Most studies of youth at risk for psychosis have capitalized on help-seeking individuals and examining predictors of transition to schizophrenia spectrum disorders. Several pre-presentation environmental variables are emerging as potential predictors of early course of psychotic illness. Interventions vary and include pharmacological and behavioural approaches. While there is no evidence that current pharmacological approaches to the treatment of schizophrenia are effective in impacting clinical risk, cognitive remediation and other behavioural treatment are increasingly used. The presentation will highlight complementary approaches we have applied to a community sample of youths at risk for psychosis and to help seeking individuals early in the psychotic illness. The early presentation is a dynamic process characterized by anxiety, depression and subthreshold positive and negative symptoms. There is evidence for cognitive deficits and neuroimaging abnormalities indicative of neurodevelopmental aberrations. The main neurocognitive deficits associated with risk for psychosis included complex cognition and social cognition. The importance of negative symptoms in the early course of psychosis and the adverse effects of neurocognitive deficits on functioning led us to examine the feasibility of remedial programs that target complex cognition and social cognition. To ameliorate cognitive deficits we are currently examining a Cognitive Remediation intervention consisting of eight 120-minute sessions in a small group format (BrainHQ modules, Posit Science Inc). To address negative symptoms and deficits in social cognition we have implemented Theater Improvisation Program to improve Social Cognition (TIPS), an 18 session CBT-informed theater training provided by professional Theater Directors. We will present preliminary results from these interventions and plans to disseminate them into publicly available intervention “toolkits” for clinicians and investigators.

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